Here Come the Candidates
HERE COME THE CANDIDATES
Unless you have been in deep space returning from a mission to the nearest star system you all are keenly aware that we are entering into a new political season ripe with a president election. This year’s active candidates include Donald Trump running as a republican with Hillary Clinton and Bernie Sanders on the Democrat side. When you go to the polls this fall you may even discover a few other names on the ballot of folks you have not heard of. The inspiration for my message to you in this journal came from a recent Sunday service at my church where 3 political candidates attended and were recognized as visitors. This is done for anyone who attends our church services as a guest. Each Sunday we see more and more of these candidates partially because our place of worship is rather large but that its congregation consists of many influential members of our community here in Tallahassee. We even had candidates visit us from as far away as 120 miles.
It is an understatement to suggest that the candidates for this year’s presidential election have sharp opinions of each other. What matters most to this editor is not what the candidates think of each other but what are their views on the issues particularly on health care? Sadly I have heard little of anything on health care other than a need to reform or repeal the affordable health care act. A lot of what I am seeing in the community is feelings that there is no viable candidate from which to choose from and that there is such a mistrust of the electoral system that the effort to vote or be involved is not worth the time. This is perhaps the most dangerous position that anyone in a free society would take. You are in effect conceding that our American system of governance is so broken and that you want no part of it. It also means that a voting eligible person is transferring decision making out of their hands and into the hands of others who could care less what you think. Can we afford to be that apathetic? Do you really want someone to go to Washington, DC or to Tallahassee, Florida to speak for you who has no clue what a pharmacist does or what purpose does a pharmacy technician does?
Remember that it does not matter whether you vote in an election or not. Someone will get elected with our without your input. When elected they will be making decisions on what your practice will look like over the next several years. Your state representative, senator or Congressional representative will have access to all of the issues that we see every day in pharmacy and with the simple push of a green or red button at their desks either help make life better for you and your patients or they will create a nightmare of epic proportions.
These candidates that are soliciting your support are dropping signs throughout your communities and speaking to your local county and city governments. They are writing opinion articles in your local newspapers and putting flyers on your automobile windshields. They are asking for your support and your vote. How about we ask a few questions of our own? Here are a few suggestions.
- Consumers have repeatedly responded in surveys that they have high respect for their neighborhood pharmacist. On occasion public policy and private contracts funded with public dollars will facilitate preference for one pharmacy provider or closed network of pharmacies over other pharmacy providers. This preference is based solely upon a particular prescription drug’s pricing alone and not consider overall health care outcomes and costs, including longer term health care costs arising from a patient’s misuse, improper utilization or non-compliance in an overall drug regimen. Could you share with us what components you believe should be used by the State to select a particular pharmacy provider for a particular patient?
- Florida’s Medicaid program cost estimates for 2016-2017 are projected to be a large portion of the state budget. Drug costs are likely a large portion of those costs. Reimbursement for pharmacy services have declined through changes in public policy and aggressive contracting by the Medicaid program’s pharmacy benefit managers. While Florida has been diligent in managing waste through aggressive fraud prevention and abuse programs, the costs are likely to continue to rise. There has also been a significant amount of integration of the pharmacy networks through mergers and closures of smaller family owned pharmacy businesses and restriction of access by the benefit plans. How do you see these trends affecting the access of pharmacy services to patients in rural and underserved areas of Florida? How can our state’s professional organizations work with state government to level the business playing field for all pharmacy providers both large and small?
- There is very little known about how prescription drug pricing is determined. Most medications provided by pharmacies are paid for by health plans that contract with unregulated, unlicensed fiscal intermediaries known as pharmacy benefit managers (“PBMs”). The profession and business of pharmacy is highly regulated either directly or indirectly through Florida statues 465, 893, 400, 409, 456, 499, administrative rule 64B16 and the Code of Federal Regulation 1304 and 1306. A fairly sizable amount of pharmacy related services (85% to 95%) are funneled through the PBM claims processing system of which the pharmacy, physician provider AND patient have little or no influence over. It is ironic that with so much activity there is virtually no oversight of PBMs by Florida regulators. It is also interesting that the growth of prescription drug costs appear to be running concurrent with public policy changes facilitating the services of the PBM. What steps do you think that government should take (if any) to provide oversight into how pharmacy benefit managers affect overall health care costs, prescription drug costs, prescription drug utilization, physician-pharmacist drug therapy decision making, patient drug decision making and fiscal responsibility to the payers of health care? Do you favor regulation of PBMs?
- The pharmacist practice act was written and authorized by the Florida legislature many years ago when the practice was very different. There have been a few modifications such as allowing for pharmacists to provide immunization services in pharmacies. This has improved access to many preventative health care services. In many states pharmacists have the ability to initiate, modify and discontinue drug therapy. These services by pharmacists may also include the provision of health and wellness services. Still the training of today’s pharmacist candidates and the services potentially available from current pharmacist providers far exceed the regulatory limits approved by the legislature and implemented by the Florida Board of Pharmacy. Pharmacists have the ability to provide a much higher level and variety of health care services however they are handicapped by the current laws and rules that they must be compliant with. What public policy changes would you like to see Florida pursue to take advantage of the advanced services that pharmacists today can provide? Do you believe that with pharmacists’ advance training in prescription drug therapy that they have the ability to be medication managers, administrators and decision make
The above few questions are by no means a complete list. You may have specific questions of your own related to an issue with your practice. If you do have an opportunity to pose these questions as well as others on your mind you should get a satisfactory answer. If you don’t then we see this either as an educational opportunity or a message that you need to talk to their political rival. We know what the answers to these questions should be. What we need to know is what the candidates think. Do they even know what role you play in health care and how necessary you are in improving outcomes and health quality? These candidates will be fighting for your support. I say that they should earn it first.
Michael A. Jackson, BPharm, CPh
Executive Vice President and CEO
Florida Pharmacy Association